Knee replacement in India got Hi tech with the introduction of the I Assist navigation tool. This case report describes how an American nurse got an advanced and durable knee replacement in India by Dr.A.K.Venkatachalam of the MJRC clinic. 

Sensor guided knee replacement attracts American to Chennai

Ms EC, a 30 year old LA nurse got a sensor guided durable knee replacement in Chennai by Dr.A.K. Venkatachalam. She had been struggling with a painful knee for 15 years and was unable to get a proper solution in her country. With her mobility restored now, she is ready to resume her profession.

Case report-Ms. EC, a 30-year young nurse from Los Angeles, USA recently got a sensor guided knee replacement in Chennai. She was suffering from osteoarthritis of her left knee for over 15 years. Her troubles began when she started to participate in sports as a teenager. She experienced periodic bouts of pain and instability. She had consulted several orthopaedic surgeons in the US and had undergone two arthroscopic surgeries. On both the occasions the surgeon advised that she needed a knee replacement. She was dissatisfied with the experience. Hailing from the medical profession she realized that due to her young age she would need at least one or two revisions in her life. She discovered that she could get a durable knee replacement implanted with a smart tool in India. A durable knee replacement which could last for 35 years would reduce or eliminate the need for revision surgery in her life.

Dr. Venkatachalam examined her and suggested that she undergo a Verilast durable knee replacement implanted with a sensor guided assist device.

She underwent the surgery about two and half weeks ago at the Chennai Meenakshi multi- specialty hospital.  She has recovered well and is ready to leave for home.

About the sensor device-

A sensor device called “I-assist” was used. The ‘I-Assist’ is a surgical guidance system designed to improve the accuracy of a total knee replacement. It assists the surgeon in aligning knee implants to each person’s unique anatomy intra operatively. This provides a personalized fit and truly tailor-made total knee replacement. It consists of two pods which are attached to knee instrumentation. These pods incorporate sensor devices like a gyroscope and WI FI. These sensors are used in aircraft and in mobile phones for navigation purposes. The outcome is very predictable as perfect alignment is achieved intra operatively. The implants themselves are not custom built. The longevity of the implant is increased with the perfect alignment. This is crucial for young patients getting a knee replaced as it would eliminate or reduce the need for a revision surgery.

About the knee implant-

A durable implant known as the Verilast knee was used. Unlike conventional knee implants which are made up of a Cobalt Chrome and Molybdenum alloy, the femoral component of this implant is made up of a precious metal called Zirconium. After fabrication the femoral component heated in a furnace at 4000°C under a high oxygen concentration. Under these conditions the surface of the metal zirconium becomes converted to a 5 µ thick layer of a ceramic known as Zirconia. Ceramic implants wear at a much slower rate in comparison to conventional metal implants. The plastic tray is made up of highly cross-linked plastic. This combination of ceramic and cross-linked plastic reduces the rate of wear. It has been calculated in experiments that these wear particles are so few that the knee could tolerate loading of sufficient number of cycles to last for 35 years.

Discussion-The demographics of knee replacement has changed in the last decade. Increasingly more number of young people is seeking knee replacements for various reasons. Conventional knee implants made up of traditional materials like Cobalt, Chrome and Molybdenum survive only for 10 to 15 years. While these implants are sufficient for older people, it is extremely important to select durable implants in younger people as they will survive longer.

The traditional method of implanting a knee uses instrumentation known as jigs. There may be a small margin of error which may be quite acceptable for older people as it does not affect the durability of the implant within their remaining life span. On the contrary, it is crucial to get perfect alignment in younger people. Methods include computer navigation, patient specific instruments and the latest “I assist”. The “I- Assist” smart tool has got several advantages over the previous methods. These are

For the patient-

·         It gives a perfectly aligned fit.

·         It eliminates waiting time required for fabrication of another smart tool known as “patient specific instruments’.

For the surgeon-

·         The surgeon can align and validate implant positioning during total knee replacement.

·         As the device is anchored in the operating field itself, it doesn’t require shifting of the surgeon’s gaze He doesn’t have to remove his visual focus from the operating field. Earlier navigation systems require the back and forth transfer of the surgeon’s gaze from the operating field to a computer monitor elsewhere several times intra-operatively.

·         Unlike prior navigation technology, the ’I-Assist’ device saves surgeons’ more time.

For the hospital-

·         It saves additional costs by eliminating pre-operative imaging.

·         It eliminates investment in an expensive navigation system. The cost benefit is passed on to the patient.

Medical tourism- Indian doctors offer latest advances in orthopedic surgery like advanced knee, hip replacements and joint preservation surgery. This patient was able to get the latest implant and technique at a very affordable price in India.

Media contact- Dr.A.K.Venkatachalam

Phone- 9176640002